Background Traumatic brain injury (TBI) impacts 42 million people per year and is especially common among veterans and individuals experiencing homelessness. Effective treatments for TBI remain a major unmet clinical need. Enriched housing environments have been shown to ameliorate TBI symptoms, however, little to no data is available relating TBI pathology to homelessness, despite TBI being two to seven times more prevalent among those experiencing homelessness than the general population. Currently, many trials for TBI therapeutics aim to mitigate neuroinflammation. Individuals experiencing homelessness likely display greater neuroinflammation due to stresses of daily living, potentially exacerbating TBI symptoms. This unique TBI patient population must be considered to design optimal treatments for all patients. 

Methods We developed a rat model of homelessness using a novel cage switching housing environment. We rotated animals (nhomeless = 18, nstandard = 18) into dirty cages daily for 37 days, simulating housing instability and unsanitary conditions. We then induced TBI with moderate controlled cortical impact TBI surgery (nhomeless = 9, nstandard = 9). Following TBI surgery, we performed 4 days of behavioral testing including the beam walk (BW), elevated body swing test (EBST), forelimb akinesia (FA), paw grasp (PG), rotarod, and elevated-T maze. 

Results Averaged over 4 days, significant differences in motor function, demonstrated impaired function in rats with TBI compared to controls, regardless of housing (BW 85.0%, FA 104.7%, and PG 100% greater deficit in TBI). Notably, however, homelessness exacerbated the functional deficits in TBI rats (BW 93.3%, FA 40.5%, and PG 50% greater deficit). TBI rats in the homelessness model also showed a surprising recovery in functional deficits on day 4, while control housing rats continued to decline. 

Conclusion These findings exhibit the magnification of certain motor insufficiencies shortly after TBI due to homelessness, possibly due to an underlying pathophysiology. Interestingly, however, TBI rats in the homeless simulation showed more robust recovery by day 4, suggesting a form of resilience to stressful events like TBI. That exacerbation of TBI symptoms accompanies homelessness suggests that the environmental condition of the patient must be considered in disease diagnosis and to aptly treat all TBI patient populations.


Neurological Surgery - Forgotten veterans: Pathological implications of homelessness on traumatic brain injury - Neurological Surgery

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Neurological Surgery - Forgotten veterans: Pathological implications of homelessness on traumatic brain injury - Neurological Surgery

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